National Association of Public Hospitals and Health Systems(NAPH)

NAPH represents America’s most important safety net hospitals and health systems, which provide high quality health services for all patients, including the uninsured. They also provide many essential community-wide services, such as primary care, trauma care, and neonatal intensive care, and educate a substantial proportion of America’s doctors and nurses.


  • Click here for Reconciliation updates and ways to take action against federal Medicaid cuts.
  • Senate Passes Reconciliation Bill; Click here for NAPH’s December 21, 2005 Alert.
  • Click here for a summary of the conference agreement.
  • Click here for NAPH’s November 21, 2005 Letter to Budget Negotiators.
  • 2006 Fellows Program: Applications due by 12-16-2005

The 2006 NAPH Fellows Program is a three-session educational program designed to provide professional networking and development for senior leaders at safety net institutions. The program will focus on how to develop, support, and sustain quality improvement and patient safety initiatives in public hospitals and health systems. The brochure contains all the details. Submit your application.

Hurricane Katrina Relief

NAPH continues to seek assistance for members affected directly and indirectly by the aftermath of hurricane Katrina. Click the heading above for more information on legislative proposals for assistance, CMS waivers, volunteering, and how you can help those affected.

IHI 100K Lives Campaign

NAPH has become a Public Hospital Node with the Institute for Healthcare Improvement’s 100,000 Lives Campaign. Members are strongly encouraged to share success stories on how they are implementing the six interventions, so that we can share these success stories with others. For further information concerning the IHI 1000,000 Lives Campaign please click above.

Medicare Outpatient Prescription Drug Coverage

Medicare outpatient prescription drug coverage begins January 2006.  Provided below are links to resources with helpful materials for providers on the implementation of this program.  These materials include applications for the limited-income subsidy, provider toolkits including posters, quickfacts, materials for patients, and high-level summaries of the program, and access to the prescription drug plan and formulary finder.

1.   Application for Beneficiaries with Limited Income and Resources

Medicare beneficiaries with limited income and resources may be able to get extra assistance paying for Medicare prescription drug plan premiums, deductibles and co-payments.  Provided below are links to websites with the low-income assistance application materials, qualification criteria, and educational resources.

2.   Provider Educational Materials

The link below connects you to resources published by the Centers for Medicare and Medicaid Services (CMS) to educate providers about the new prescription drug benefit.  These resources include training materials, educational documents for patients and providers, as well as posters, timelines, and one-page fact sheets.

3.   Prescription Drug Plan and Formulary Finder

Medicare beneficiaries must choose a plan if they would like to take advantage of the prescription drug coverage.  A link to the Prescription Drug Plan Finder is provided below.  The purpose of the Formulary Finder is to allow Medicare clients to search which Prescription Drug Plans in their state have the drugs they require.

Many of the documents available on this website must be viewed using Adobe’s Acrobat Reader.If you do not yet have Acrobat Reader,

New Resource Area on Disaster Preparedness & Bioterrorism

This new area of the “Our Issues” section of our website assembles in one place many useful internet resources which may help public hospitals and health systems respond to current health care challenges resulting from the events of September 11.

NAPH has over 110 members in the nation’s largest urban areas. They are a diverse set hospitals and health systems with a vital mission: providing services to all, regardless of their ability to pay. This section of our website will:

Help you understand what a Safety Net hospital is and how it differs from other types of hospitals.

Answer frequently asked questions about the Safety Net hospitals; for example, who are the people they serve, what kinds of services do they provide, and how are they financed?

Give you data on key indicators of public hospital operations; for example, average number of outpatient visits and uncompensated care as a percent of total costs.

This section also includes a search function that allows you to locate NAPH member institutions either by name or by state, and link to their website so that you can learn more about the Safety Net hospitals in your area.

Through advocacy, research and education, NAPH addresses a broad range of issues that affect public hospitals and the people and communities they serve, including changes in the health care delivery system, the management and operations of the Safety Net hospitals, and the organization and delivery of health care services to the uninsured. Click on any of the links below to view an essay on that issue. Most essays include links to other, more detailed analyses of those issues and to related areas of our website.

Disaster Preparedness & Bioterrorism

This section of Our Issues provides a downloadable list of websites and other internet resources about disaster preparedness and bioterrorism.

Legislative and Regulatory Reference Center

This area of our website conveniently assembles in one place all current and recent NAPH documents on legislative and regulatory issues in these six categories:

  • Testimony
  • Letters
  • Regulatory Comment Letters
  • Legislative/Regulatory Summaries and Alerts
  • Talking Points and Fact Sheets
  • Statements and Press Releases

Improving Access to Health Care for the Uninsured

Approximately 42 million people in the U.S. lack any form of health insurance coverage. For these individuals, the country has developed an institutional health care safety net to ensure that they nevertheless receive access to needed care. This institutional safety net is comprised of the many hospitals, clinics and individual providers who serve all who seek their care without regard to ability to pay. NAPH and its members work hard to preserve this safety net and assure access to health care for the uninsured.

Improving Access to Care – Coverage Expansion Proposals

NAPH strongly supports all efforts to improve access to healthcare for America’s 42 million uninsured, including programs which expand coverage for individuals and families who currently lack health insurance coverage, and programs which provide support for the safety net institutions which bear the greatest burden for serving the uninsured. Federal and state policymakers must continue to build on the momentum that has been established following the enactment of the State Children’s Health Insurance Program (SCHIP) program by extending coverage to new groups of individuals and families.

Preserving the Health Care Safety Net

NAPH endorses initiatives that will sustain the health care safety net, including proposals to: permanently restore full Medicaid DSH allotments, fully fund the Community Access Program, Modernize Medicare provider reimbursment, ensure ongoing monitoring of the stability of the safety net, and address crippling workforce shortages.

Community Access Program

As part of its 2000 legislative agenda, NAPH worked with its members to get increased appropriations and authorizing legislation for the Community Access Program (CAP), which provides grants to safety net providers at the community level to improve access to health care for the uninsured. Congress provided $25 million in demonstration funding for the project in FY 2000 and recently appropriated $125 million in FY 2001 to expand grants to additional communities. NAPH is seeking authorizing legislation to extend this demonstration program and will continue to advocate for increased appropriations in FY 2002.


The Medicaid program is a joint federal-state entitlement program through which low-income Americans are afforded access to health care. It is the primary source of health care coverage for low-income families with children, the low-income elderly and disabled people.

Medicaid Disproportionate Share Hospital Program

Congress established the Medicaid Disproportionate Share Hospital (DSH) program in 1981 to ensure that state Medicaid programs provide adequate payments to hospitals whose patient populations are disproportionately composed of low income Medicaid and uninsured patients. The Medicaid DSH program has evolved into one of the most important sources of financing for the substantial amounts of uncompensated care provided by safety net hospitals, including NAPH members.

Medicaid: Obstacles to Enrollment and Suggestions for Improvement

NAPH has long supported efforts to increase access to health care for all Americans, including expanding coverage through programs such as Medicaid and the State Children’s Health Insurance Program (SCHIP). While expanded coverage is critical to providing access, it is only part of the equation – of equal or even greater importance is ensuring that all individuals who are eligible for existing health coverage programs get enrolled in them.

Revisions to Medicaid Upper Payment Limits

The Health Care Financing Administration (HCFA) recently published final regulations revising the Medicaid upper payment limits (UPLs), which limit state flexibility in setting Medicaid payment rates. HCFA’s revised regulations were designed to address the serious concern that some state payment methodologies do not benefit Medicaid recipients. NAPH and many others were concerned that the revised regulations could inadvertently impact legitimate methodologies, and therefore harm safety net providers, vulnerable patients, and long-standing state programs that should not be of concern to HCFA.

Benefits Restoration for Legal Immigrants

NAPH members are committed to providing health care services to all patients regardless of ability to pay or immigration status. Safety net providers have traditionally served as the providers of choice for immigrant populations, and uninsured immigrants often rely on safety net institutions for their health care services. The loss of Medicaid coverage for this population has added to the uncompensated care burden shouldered by safety net providers, at a time when more uninsured patients are seeking care from them and federal and state sources of reimbursement for uncompensated care are shrinking.

State Children’s Health Insurance Program

In 1997, a bipartisan group of lawmakers approved the largest expansion of health insurance coverage in more than 30 years, the State Children’s Health Insurance Program (SCHIP). SCHIP was designed to expand and complement the Medicaid program by providing health coverage for uninsured children whose families earn too much to qualify for traditional Medicaid but who are too poor to afford private coverage on their own.

What is Medicare?

In addition to providing health coverage for America’s senior citizen population, the Medicare program provides important subsidies for uncompensated care and graduate medical education expenses. In particular, Medicare provides support to the hospitals that serve our nation’s poorest and most vulnerable citizens through the Medicare Disproportionate Share Hospital (DSH) and to the teaching hospitals through the Graduate Medical Education (GME) programs. With this in mind, NAPH is actively engaged in the ongoing public policy debate on Medicare issues, with a particular interest in those that relate to provide access to care for the elderly and other vulnerable populations, as well as train physicians and other health professionals.

Medicare: Disproportionate Share Hospital Program

The Medicare DSH program is a major focus of NAPH’s advocacy on Medicare issues. Under this program, Medicare provides supplemental payments to hospitals that treat a large portion of low-income individuals. Congress established the program in the 1980s to recognize higher costs incurred in treating a disproportionately high number of low-income patients and to ensure access to care for Medicare patients.

Medicare: Graduate Medical Education

In addition to providing health coverage for seniors and supplemental payments to hospitals that serve a disproportionate share of low-income patients, the Medicare program provides substantial funding to subsidize the cost of training medical residents. Almost three-quarters or 73 percent of NAPH members are teaching hospitals; in 1998, our members were responsible for training approximately 16 percent of all residents.

Medicare Outpatient Prospective Payment System

Acting under the authority granted by the Balanced Budget Act of 1997 (BBA), on August 1, 2000, the Health Care Financing Administration (HCFA) implemented the outpatient prospective payment system (OPPS) for hospitals. Prior to the change, Medicare paid hospitals on a cost basis for outpatient services. Under the new system, all outpatient services are classified into groups called Ambulatory Payment Classifications (APCs). In addition to changing the reimbursement method for outpatient services, the regulations imposed new requirements on providers. While NAPH supported the general intention behind the provider-based designation rules, we felt that the new regulations would have significant unintended consequences for safety net health systems.

Medicare Reform

Proposals to reform and modernize the Medicare program are among the leading health issues currently on the congressional and Bush administration agendas. NAPH recognizes that the Medicare program must undergo reforms if it is to remain financially viable for future generations. However, we believe that program changes should be implemented in a way that guarantees coverage and benefits and improves access and quality of care for our nation’s elderly and disabled citizens.

What is EMTALA?

The Emergency Medical Treatment and Active Labor Act (EMTALA), also known as the “anti-patient dumping” legislation, was designed to ensure that persons who come to an emergency room are not denied care based on financial ability to pay or on insurance status. NAPH has long been a strong supporter of EMTALA and its purposes. Since NAPH institutions provide care regardless of income or insurance status, they are generally more likely to be on the receiving end of patients “dumped” by other institutions due to financial concerns. Dumping patients jeopardizes both the health of the patients and the financial stability of the safety net.

The 340B Drug Pricing Program

In November 1992, Congress enacted Section 340B of the Public Health Service Act (created under Section 602 of the Veterans Health Care Act of 1992), which requires pharmaceutical manufacturers participating in the Medicaid program to enter into a second agreement with the Secretary under which the manufacturer agrees to provide discounts on covered outpatient drugs purchased by specified government-supported facilities, called “covered entities,” that serve the nation’s most vulnerable patient populations.

The Safety Net Hospital Workforce

While all hospitals are feeling the effects of a tighter labor market, safety net hospitals are disproportionately impacted. The competitive pressures at safety net hospitals are compounded by their heavy reliance on dwindling government sources of funding for the wide range of services they provide. Caring for the uninsured is a greater burden on safety net hospitals than others. Furthermore, public hospitals are often bound by governance and other restrictions that limit their flexibility to change job descriptions or make quick changes in compensation, benefits and hiring practices to respond to market demands

Advanced Access A New Paradigm Download
NAPH_FY_06_Reconciliation_Conference_Letter_11-21-05 Download
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